LandUseApplication.pdfCity of Edmond
Land Use Application
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ARCHITECTURAL DESIGN REVIEW
LCOMPREHENSIVE PLAN AMENDMENT
:.r CONDITIONAL USE PERMIT
� I )'TOME OCCUPATION
FORMAL SUBDIVISION
SHORT SUBDIVISION
LOT LINE ADJUSTMENT
PLANNED RESIDENTIAL, DEVELOPMENT
LI Ol'HCIAL STREETMAP AMENDMENT
F STREET VACATION
REZONE
SHORELINE 13 RTAIT
J VARIANCF,, 1 REASONABLE USF. EXCEPTION
LI OTHER,: _
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DAPE�REC'DBY 1r_
FEL `."D -r) « t.;j (", RECEIPT 4 __... .
f IE.ARING DATE
U HE 'STAFF ' I I3I3 -1 ADB i l CC
o PLEASE." NOTE TIIATALL INFORM I TION CONTARVED IFITIIIN TIlE APPLICATION ISA PUBLIC RECORD o
PROPERTY ADDRESS oIt LOCATION 21616 80th Ave W Edmonds, WA 98026
PROJECT NAME (IF APPLICABLE) N/A
PROPER,rYOWNL'R Yvonne Sloan PHONE#_ 4255-361-2509
ADDRESS 21616 80th Ave W, Edmonds, WA 98026
F -MAIL von@communitynorthwest.com FAX p 206-694-2404
TAX ACCOUNT#
27043000100500
SEC. 30 TWP. 27._—R11G. 04RT 4B
DESCRIPTION OF PROJECTOR PROPOSI?D I.ISE (ATTACH COVER LETTER AS NECESSARY), AEU for living Space
for senior mother. -----
DESCRIBE I IOW THIS PROJECT MEETS APPLICABLE, CODES (ATTACII COVER I.ETT'ER AS NECESSARY)
Project meets square footage requirements, parking-, family statps-and allotbeuegutrenaents_.
outlined by the City of Edmonds.
APPLICANT Yvonne Sloan _ _PHONE# 425-361-2509 or 206-947-3398
ADDRESS 21616 80th Ave W Edmonds, WA 98026
E-MAIL von@communitynorthwest.com FAX # 206-694-2404
CONTACT PERSON/AGENT
ADDRESS
E-MAIL
HONE #
FAX #
'Elie undersigned applicant, and hisiber/its hems, and assigns, in consideration on the processing of tho application agrees to
release, indetunify, defend and hold the City ofE.dtrionds harmless frotu any and all datnages, including, reasonable attorney's
fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or incomplete information
furnished by the applicant, his/her/its agents or employees -
By my signature, I certify that the information and exhibits herewith submitted arc true and correct to the best of my knowledge
and that lain authorized to the this application on the behalf of the owner as listed below.
SIGNATURE OP APPLICAN'r/AGENT
Property Owner's Authorization
DATE. May 9, 2013
1 Yvonne Sloan certify under the penalty of perjury under the laws orf t1ue State of
Washington that the following is a true and correct statement: I have authorized the above Applicant/Agent to apply for the
subject land use application, and grain my permission for the public officials and the staff of the City of Edmonds to enter the
subject property for the proposes of inspection and posting attendant to this application.
SIUNATURE OF OWNERDATEy
Ma 9, 2013
Questions" Call (425) 771-Q2�0.
Revised on 812:112 R -Land Use 11 pnticatirm Page 1 O(1